Apoptosis in murine duodenum during embryonic development

 Duodenum is thought to go through a solid-core stage followed by recanalization during its development. This study investigates the role of apoptosis in normal duodenal development, especially during widening of the lumen, and hence, the possible role of apoptosis in duodenal atresia (DA). Twenty-four time-mated Sprague-Dawley rats were killed from day 13 to day 20 of gestation. Duodenums of 3 fetuses were chosen randomly from each rat and processed. Apoptosis was determined by the terminal deoxytransferase-mediated biotin dUTP nick-end labeling (TUNEL) technique (ApopTag). Apoptosis count and cross-sectional areas were measured with an image analyzer (MetaMorph). The number of apoptotic cells per unit area duodenum peaked on day 15 for the mucosal/submucosal layer and on day 14 for the muscular/mesenchymal layer. The maximal number of apoptotic cells per cross-section of duodenum was between 7 and 8. The cross-sectional areas of the duodenal wall and lumen increased exponentially between day 17 and day 19 while duodenal-wall thickness remained relatively constant throughout duodenal development. The localization, timing, and intensity of apoptosis do not suggest that apoptosis is responsible for the widening of the duodenal lumen; enlargement of the lumen is related to the increase in duodenal circumference. Apoptosis thus may not be involved in the pathogenesis of DA. Accepted: 8 November 1999     

创伤性十二指肠损伤的诊治

目的:探讨创伤性十二指肠损伤的诊断及治疗方法。方法:回顾性分析27例十二指肠损伤患者采用十二指肠修补横行缝合关闭裂口、大网膜覆盖固定10例(其中包括合并小肠切除吻合2例,小肠破裂修补3例,肠系膜破裂修补2例),缝合修补加胃造瘘6例,十二指肠修补加胃造瘘和空肠造瘘3例,十二指肠修剪或部分切除后端端吻合2例,十二指肠修补加憩室化手术3例,十二指肠裂口与空肠Roux-en-Y型吻合术2例,胰十二指肠切除术1例。结果:27例患者有1例死于胰瘘和腹腔出血,病死率为3.7%,术后并发症发生率为25.9%。结论:十二指肠损伤漏诊率高,术前重视受伤特点、临床表现、完善检查,术中仔细探查是诊断的关键。     

Duodenal duplication with bile duct obstruction and keratinaceous casts

We report an unusual case of duodenal duplication presenting in a newborn with duodenal and bile duct obstruction. The duplication and biliary tract were filled with keratinaceous casts. To our knowledge, such an association has not been previously reported; this case demonstrates the importance of confirming bile duct patency during operations to remove duodenal duplications.     

27. Retroperitoneale Duodenal- und Pankreasverletzung

Zusammenfassung Die Prognose hdngt von der rechtzeitigen operativen Intervention ab. Kontusionen und Hdmatome des Pankreas werden mit Drainage der Bauchhöhle behandelt. Eine Läsion des Pankreasganges erfordert die Resektion oder eine Anastomose mit dem Dünndarm. Frische Duodenal-perforationen lassen sich mit primärer Naht versorgen. Bei ausgedehnten Zerreißungen kann die Magenresektion, kombiniert mit selektiver Vagotomie angezeigt sein, selten die Duodenopankreatektomie. Ob Duodenalwandhämatome operiert werden müssen oder konservativ behandelt werden können, richtet sich nach den klinischen Symptomen.     

Management of duodenal injuries in children

Background/purpose

The natural history and management of pediatric duodenal injuries are incompletely described. This study sought to review injury mechanism, surgical management, and outcomes from a collected series of pediatric duodenal injuries.

Methods

A retrospective chart review was conducted for a 10-year period of all children less than 18 years old treated for duodenal injuries at 2 pediatric trauma centers.

Results

Forty-two children were treated for duodenal injuries. There were 33 blunt and 9 penetrating injuries. Injuries were classified using the Organ Injury Scale for the Duodenum. Twenty-four patients underwent operative management by primary repair (18), duodenal resection and gastrojejunostomy (4), or pyloric exclusion (2). Duodenal hematomas were treated nonoperatively in 94% of cases. The average ISS for operative versus nonoperative cases was 23 and 10, respectively. Delay in diagnosis or operative intervention (>24 hours) was associated with increased complication rate (43% v 29%) and hospitalization (32 v 20 days). Nine children requiring surgery experienced delays and were most highly associated with foreign body, child abuse, and bicycle injuries. There were no deaths caused by duodenal injuries.

Conclusions

Duodenal injuries in children were predominantly blunt and had a low mortality rate. When surgery was required, primary repair was usually feasible.     

The SLC40 basolateral iron transporter family (IREG1/ferroportin/MTP1)

The iron regulated-transporter-1 (Ireg1, also known as ferroportin or metal transporter protein-1, MTP1) appears to be the sole member of the SLC40 transporter family. It functions as a universal efflux pathway for iron in a number of cell types. The protein is most highly expressed in mature enterocytes of the duodenum, in syncytiotrophoblasts, which separate foetal and maternal circulations in the placenta, and in macrophages responsible for recycling iron from breakdown of aged red blood cells.     

Physiological and behavioural responses to duodenal pain in freely moving rats

Luminal distention of the intestine can be aversive in humans and laboratory animals, and hypersensitivity to distention is found in functional gastrointestinal disorders. Current animal models either require anaesthesia or acute balloon intubation or use implanted balloons of irritant materials, for which the aversive quality of distention and physiological responses have not been well characterised. We report here that silicone balloon catheters implanted in the duodenum via the stomach have long patency without obvious tissue damage. Balloon inflation in freely moving rats caused passive avoidance learning and classic 'pain' postures, as well as graded cardiovascular responses which can be recorded telemetrically. The method should make long-lasting studies of pharmacological and environmental effects on visceral sensitivity more feasible.     

Gastric satiation is volumetric, intestinal satiation is nutritive

Gerry Smith's thoughtful survey in his book Satiation (1998) outlined the established principles of gastric and intestinal satiation and delineated several questions still requiring clarification. Experiments since the time of the review have addressed some of these questions. A synthesis of the principles outlined in the Gerry Smith survey and the subsequent experimental results indicates that the direct controls, or neural feedback signals from the GI tract, that limit meal size consist of gastric volumetric signals and intestinal nutritive signals. The two types of negative feedback synergize in the control of feeding, and both are carried by vagal afferents.     

Cystic dystrophy in heterotopic pancreas of the second part of the duodenum. One case of conservative surgical procedure

Duodenal cystic dystrophy due to ectopic pancreas deposit is an uncommon pathology. Diagnosis is made by modern imaging techniques, mainly endoscopic ultrasound which localizes precisely cysts in duodenal wall. The most frequent clinical symptoms are pain, duodenal obstruction, and weight loss. We report the case of a 40 year-old man with cystic dystrophy of the 2nd part of the duodenum, without chronic pancreatitis, treated by a conservative surgical procedure including segmental duodenal resection. This original approach is an alternative to the Whipple procedure.     

十二指肠恶性肿瘤的影像诊断

目的回顾性分析十二指肠恶性肿瘤的影像所见。方法原发肿瘤１３例,继发肿瘤３例,１６例病人均行上消化道气钡双重造影。５例病人行ＣＴ检查,２例行血管造影,２例壶腹部癌行Ｂ超检查,其中１例行ＥＲＣＰ检查。结果所有病人均经手术切除,将Ｘ线所见与病理结果对照分析,腺癌７例,平滑肌肉瘤６例,继发性癌３例。结论消化道造影是十二指肠病变的首选检查方法。本组病例均能提示病变部位,其中１３例定性诊断正确,但对一些外生性肿瘤,造影有其局限性,应结合ＣＴ、Ｂ超综合诊断。